An Unusual Case of Asymmetrical Limb Spasticity in Tetanus

Tetanus, a serious bacterial infection by toxin-producing anaerobe Clostridium tetani, is a major public health concern in India, which causes significant morbidity and mortality with case fatality rates ranging from 16.5 to 53.6% (Surabhi et al., 2022; Sodha et al., 2018; Masthi et al., 2008). A classical presentation of tetanus is of a descending pattern of muscle spasms, with the initial symptom being lockjaw and risus sardonicus, followed by stiffness of the neck and limbs (Abrahamian et al., 2000). However, this patient showed initial lower limb spasticity, progressing asymmetrically, which, combined with trauma history and hypertonicity, raised strong suspicion of tetanus. The improvement in the patient's clinical status with tetanus immunoglobulin further confirmed the diagnosis.